• Our Providers
    • Peter Maurice, MD
    • David Santos, MD
    • David Green, MD
    • Chad Ruffin, MD
    • Audiologists
  • Our Services
    • Nasal & Sinus Treatment
    • Allergy Testing & Treatment
    • Sleep Apnea & Snoring
    • Pediatric ENT
    • Otology
    • Head & Neck Surgery and Cancer Care
    • Throat, Voice & Swallowing Disorders
    • Facial Plastics
  • Hearing Aids
  • Patient Resources
    • New Patient Information
    • New Patient Forms
    • Pre & Post Operative Instructions
    • Referring Providers
    • Insurance
  • Locations
    • Our Clinic
    • Outpatient Surgery
  • Make An Appointment
  • Pay Online
Proliance South Seattle Otolaryngology
  • Our Providers
    • Peter Maurice, MD
    • David Santos, MD
    • David Green, MD
    • Chad Ruffin, MD
    • Audiologists
  • Our Services
    • Nasal & Sinus Treatment
    • Allergy Testing & Treatment
    • Sleep Apnea & Snoring
    • Pediatric ENT
    • Otology
    • Head & Neck Surgery and Cancer Care
    • Throat, Voice & Swallowing Disorders
    • Facial Plastics
  • Hearing Aids
  • Patient Resources
    • New Patient Information
    • New Patient Forms
    • Pre & Post Operative Instructions
    • Referring Providers
    • Insurance
  • Locations
    • Our Clinic
    • Outpatient Surgery
  • Make An Appointment
  • Pay Online

New Patient Forms

New Patient FormsFilling out this paperwork prior to coming in for your visit will allow you more time to talk to the doctor about your specific concerns.  We look forward to seeing you.  Click on the bolded PDFs below to print and fill out relevant forms.  If you have difficulty printing the forms, they can be provided to you by our staff upon request.  You will need to allow for extra time to fill out the information the day of your appointment.

All New Patients:
To expedite your appointment all new patients are encouraged to please print all 4 forms below (there may be other forms below that could be applicable for your specific care).  Please bring them completed to your upcoming appointment. 
  • New Patient Registration Form PDF
  • HIPAA form PDF
  • New Patient Health History PDF
  • Patient Financial Responsibility PDF


DETAILED FORMS FOR SPECIFIC PATIENTS (review and select as necessary):

Nasal/sinus patients:
If you are a new patient seeing our sinus doctors for concerns related to nasal/sinus/allergy symptoms please print and fill out the following before your first appointment:
  • Nasal / sinus questionnaire PDF
  • Sino-nasal outcome test (SNOT 22) PDF

Allergy patients:
If you are a new patient seeing our allergy physicians for concerns related to allergy symptoms please print and fill out the following before your first appointment:
  • Allergy questionnaire PDF
  • Nasal / sinus questionnaire PDF
  • Sino-nasal outcome test (SNOT 22) PDF

Allergy forms and FAQs
Once your allergy doctor assesses whether you will require allergy testing, the following forms will be necessary to review and fill out before your first appointment:
  • Consent for Allergy Skin Testing PDF
  • Patient preparation for allergy test PDF

Ear patients:
If you are a new patient seeing our ear doctors for concerns related to ear conditions or symptoms, please print and fill out the following before your first appointment:
  •  Ear questionnaire PDF

Snoring/sleep apnea patients:
If you are a new patient seeing our sleep apnea doctors for concerns related to snoring and obstructive sleep apnea, please print and fill out the following before your first appointment:
  • Sleep questionnaire PDF

Hoarseness patients:
If you are a new patient seeing our voice doctors for concerns related to hoarseness please print and fill out the following before your first appointment:
  • Hoarseness questionnaire PDF

Pediatric patients:
If you are a parent/family member of a new pediatric patient please print and fill out the following before your first appointment:
  • New Pediatric Health Questionnaire PDF
  • Consent for care of minor by non-parent PDF (not needed if parent or guardian is present)

Transfer patients:
If you are interested in releasing your medical information from another physician's office to Proliance South Seattle Otolaryngology these forms can assist you in your efforts:
  • Transfer of medical information PDF                                                               
Phone: (206) 242-3696
​Address: 16259 Sylvester Rd SW 
                 Suite #505
                 Burien, WA 98166

​Proudly serving West Seattle, White Center, Burien, Normandy Park, Des Moines and the Greater South Sound Region since 1963

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© 2021 Proliance South Seattle Otolaryngology
  • Our Providers
    • Peter Maurice, MD
    • David Santos, MD
    • David Green, MD
    • Chad Ruffin, MD
    • Audiologists
  • Our Services
    • Nasal & Sinus Treatment
    • Allergy Testing & Treatment
    • Sleep Apnea & Snoring
    • Pediatric ENT
    • Otology
    • Head & Neck Surgery and Cancer Care
    • Throat, Voice & Swallowing Disorders
    • Facial Plastics
  • Hearing Aids
  • Patient Resources
    • New Patient Information
    • New Patient Forms
    • Pre & Post Operative Instructions
    • Referring Providers
    • Insurance
  • Locations
    • Our Clinic
    • Outpatient Surgery
  • Make An Appointment
  • Pay Online